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Distal radius fractures are common and are managed with or without surgery. Current evidence indicates surgical treatment is not superior to nonsurgical treatment at 12 months.Does surgical treatment for displaced distal radius fractures in patients 60 years or older provide better patient-reported wrist pain and function outcomes than nonsurgical treatment at 24 months?In this secondary analysis of a combined multicenter randomized clinical trial (RCT) and a parallel observational study, 300 patients were screened from 19 centers in Australia and New Zealand. Of these, 166 participants were randomized to surgical or nonsurgical treatment. Participants who declined randomization (n = 134) were included in the parallel observational group with the same treatment options and follow-up. Participants were followed up at 3, 12, and 24 months by a blinded assessor. The 24-month outcomes are reported herein. Data were collected from December 1, 2016, to December 31, 2020, and analyzed from February 4 to October 21, 2021.Surgical treatment consisting of open reduction and internal fixation using a volar-locking plate (VLP group) and nonsurgical treatment consisting of closed reduction and cast immobilization (CR group).The primary outcome was patient-reported function using the Patient-Rated Wrist Evaluation (PRWE) questionnaire. Secondary outcomes included health-related quality of life, wrist pain, patient-reported treatment success, patient-rated bother with appearance, and posttreatment complications.Among the 166 randomized and 134 observational participants (300 participants; mean [SD] age, 71.2 [7.5] years; 269 women [89.7%]), 151 (91.0%) randomized and 118 (88.1%) observational participants were followed up at 24 months. In the RCT, no clinically important difference occurred in mean PRWE scores at 24 months (13.6 [95% CI, 9.1-18.1] points for VLP fixation vs 15.8 [95% CI, 11.3-20.2] points for CR; mean difference, 2.1 [95% CI, -4.2 to 8.5]; P = .50). There were no between-group differences in all other outcomes except for patient-reported treatment success, which favored VLP fixation (33 of 74 [44.6%] in the CR group vs 54 of 72 [75.0%] in the VLP fixation group reported very successful treatment; P = .002). Rates of posttreatment complications were generally low and similar between treatment groups, including deep infection (1 of 76 [1.3%] in the CR group vs 0 of 75 in the VLP fixation group) and complex regional pain syndrome (2 of 76 [2.6%] in the CR group vs 1 of 75 [1.3%] in the VLP fixation group). The 24-month trial outcomes were consistent with 12-month outcomes and with outcomes from the observational group.Consistent with previous reports, these findings suggest that VLP fixation may not be superior to CR for displaced distal radius fractures for patient-rated wrist function in persons 60 years or older during a 2-year period. Significantly higher patient-reported treatment success at 2 years in the VLP group may be attributable to other treatment outcomes not captured in this study.ANZCTR.org Identifier: ACTRN12616000969460.

open access article The purpose of this article is to study the effect of moisture content on the molecular dynamics of freeze-dried disaccharide excipients, in the context of understanding the instability of a pharmaceutical product. Four di saccharides were measured by broad band dielectric spectroscopy, over a wide temperature range (− 140 to +80 ◦C) with increasing moisture content from 1 to 7.5%. The two observed sub-Tg relaxation processes (β and γ) were affected by the moisture content, with a dramatic change in relaxation time of the β-process, but only a moderate effect on the γ-process. A suggestion of the likely arrangement of dipoles, and intra-molecular mobility, was performed in the framework of the free-space theory and based primarily on the analysis of the relaxation times, activation energies and Frohlich parameters. This analysis allows for some speculation concerning the disaccharide moisture buffering in freeze-dried formulations.

It is with great sadness that we report the death of Professor Ted Milton (Figure 1). Figure 1. Ted hiking in the Picos De Europa mountains in northern Spain in 2017 (photograph courtesy of Stephan...

The demand for small bowel (SB) capsule endoscopy (CE) is increasing in the UK. However, there remains a wide variation in the number of CE procedures performed in different centres. Across the UK there is a lack of a clear training pathway or certification process. A standardised national Joint Advisory Group (JAG) on Gastrointestinal Endoscopy approved a 1-year training and accreditation programme accessible to all professional groups that may wish to train in SB CE. Structured training is delivered using JAG-accredited CE courses and an electronic learning module. Prior to setting a knowledge-based assessment, a minimum of 50 SB CE cases are recommended to be read in tandem with a trainer at a local centre, with proficiency documented using Direct Observation of Procedural Skill (DOPS) assessments.

Underperformance can be defined as performance which persistently falls below a desired minimum standard considered acceptable for patient care. Within gastrointestinal endoscopy, underperformance may be multifactorial, related to an individual’s knowledge, skills, attitudes, health or external factors. If left unchecked, underperformance has the potential to impact on care and ultimately patient safety. Managing underperformance should be a key attribute of high-quality endoscopy service, as recognised in the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) accreditation process. However, it is recognised that not all services have robust mechanisms to do this.This article provides the JAG position on managing underperformance in endoscopy, defined through a practical framework. This follows a stepwise process of detecting underperformance, verification, identification of additional causative factors, providing support and reassessment. Detection and verification of issues may require use of multiple evidence sources, including performance data, feedback and appraisal reports. Where technical underperformance is identified, this should be risk stratified by potential risk to patient safety. Support should be tailored to each individual case based on the type of underperformance detected, any causative factors with an action plan developed. Support may include coaching, mentoring, training and upskilling. Wider support from the medical director’s office or external services may also be required. Monitoring and reassessment is a crucial part of the overall process.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. Through-vial impedance spectroscopy (TVIS) is a new approach for characterizing product attributes during freeze-drying process development. In this study, a pair of copper foil electrodes was attached to the external surface of a Type I glass tubing vial, of nominal capacity 10 mL and containing 3.5 g of an aqueous solution of 5% w/v lactose, and the impedance spectrum of the vial and contents recorded during a lyophilization cycle. The cycle included a temperature ramp in the primary drying stage in order to induce a collapse event in the dry layer. Using the peak in the dielectric loss spectrum, associated with the dielectric relaxation of ice, methods were developed to predict the sublimation rate and the ice interface temperature at the sublimation front, from which the dry layer resistance was then calculated. A four-fold increase in sublimation rate and a reduction in the dry layer resistance wereobserved once the ice interface temperature reached −33 °C, which coincides with the onset of the glass transition (as determined by DSC) and the time point at which micro-collapse occurred (as evidenced by SEM images at the end of the cycle). This work suggests a prospective application of impedance measurements in driving process efficiencies by operating the dryer at the highest achievable temperature (i.e. the collapse temperature) whilst avoiding macro-collapse.

Background We are performing a combined randomised and observational study comparing internal fixation to non-surgical management for common wrist fractures in older patients. This paper describes the statistical analysis plan. Methods/design A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE) is a randomised controlled trial comparing two types of usual care for treating wrist fractures in older patients, surgical fixation using volar locking plates and non-surgical treatment using closed reduction and plaster immobilisation. The primary aim of this comparative-effectiveness study is to determine whether surgery is superior to non-surgical treatment with respect to patient-reported wrist function at 12 months post treatment. The secondary outcomes include radiographic outcomes, complication rates and patient-reported outcomes including quality of life, pain, treatment success and cosmesis. Primary analysis will use a two-sample t test and an intention-to-treat analysis using the randomised arm of the study. Statistical analyses will be two-tailed and significance will be determined by p Discussion This statistical analysis plan describes the analysis of the CROSSFIRE study which aims to provide evidence to aid clinical decision-making in the treatment of distal radius fractures in older patients. Trial registration CROSSFIRE was approved by The Hunter New England Human Research Ethics Committee (HNEHREC Reference No: 16/02/17/3.04). Registered on 22 July 2016 with The Australian and New Zealand Clinical Trials Registry (ANZCTR Number; ACTRN12616000969460). This manuscript is based on v.11 of the statistical analysis plan. A copy of v.11, signed by the chief investigator and the senior statistician is kept at the administering institution.

BACKGROUND The Joint Advisory Group on Gastrointestinal Endoscopy basic skills in colonoscopy (BSC) course was introduced in 2009 to improve colonoscopy training within the United Kingdom, but its impact on trainee performance is unknown. AIM To assess whether attendance of the BSC could improve colonoscopy performance. METHODS Trainees awarded colonoscopy certification between 2011-2016 were stratified into 3 groups according to pre-course procedure count (< 70, 70-140 and > 140). Study outcomes, comprising the unassisted caecal intubation rate (CIR) and the performance indicator of colonic intubation (PICI), were studied over the 50 procedures pre and post- course. Interrupted time series analyses were performed to detect step-change changes attributable to the course. RESULTS A total of 369 trainees with pre-course procedure counts of < 70 (n = 118), 70-140 (n = 121) and > 140 (n = 130) were included. Over the 50 pre-course procedures, significant linear improvements in CIR were found, with average increases of 4.2, 3.6 and 1.7 percentage points (pp) per 10 procedures performed in the < 70, 70-140 and > 140 groups respectively (all P < 0.001). The < 70 procedures group saw a significant step-change improvement in CIR, increasing from 46% in the last pre-course procedure, to 51% in the first procedure post-course (P = 0.005). The CIR step-change was not significant in the 70-140 (68% to 71%; P = 0.239) or > 140 (86% to 87%; P = 0.354) groups. For PICI, significant step-change improvements were seen in all three groups, with average increases of 5.6 pp (P < 0.001), 5.4 pp (P = 0.003) and 3.9 pp (P = 0.014) respectively. CONCLUSION Attendance of the BSC was associated with a significant step-change improvement in PICI, regardless of prior procedural experience. However, CIR data suggest that the optimal timing of course attendance appears to be at earlier stages of training (< 70 procedures).

Food and nutrition insecurity occurs when healthy and safe food cannot be obtained by socially acceptable means and arises as a result of complex interactions between socioeconomic and demographic determinants. These factors contribute to discrepancies in health and well-being between men and women and may also explain differential rates of food insecurity. The objectives of this cross-sectional study were to investigate the intersection between gender, education, nutrition knowledge and food security status within a high-income country context. Australian adults over 16 years of age who identified as having primary responsibility for food in their household were recruited via social media and a panel. Respondents completed a self-administered survey that included sociodemographic data, nutrition-related knowledge and food security status. Food security was measured using the Australian Household Food and Nutrition Security Scale an adapted version of the United States Department of Agriculture Household Food Security Survey. Among the 1010 survey respondents, household food insecurity (HFI) was highly prevalent (43% were food insecure, with 26% of these severely food insecure). Gender may affect associations between education, nutrition knowledge and HFI. Education was significantly associated with HFI among women but not among men. Conversely, nutrition knowledge was significantly inversely associated with food security among men but not among women. Differences in determinants of HFI exist between men and women, and programs aimed at addressing food insecurity may be more effective if tailored accordingly to account for the social and demographic factors associated with HFI.

It is critical that health service evaluation frameworks include Aboriginal people and their cultural worldviews from design to implementation. During a large participatory action research study, Elders, service leaders and Aboriginal and non-Aboriginal researchers co-designed evaluation tools to test the efficacy of a previously co-designed engagement framework. Through a series of co-design workshops, tools were built using innovative collaborative processes that foregrounded Aboriginal worldviews. The workshops resulted in the development of a three-way survey that records the service experiences related to cultural safety from the perspective of Aboriginal clients, their carer/s, and the service staff with whom they work. The surveys centralise the role of relationships in client-service interactions, which strongly reflect their design from an Aboriginal worldview. This paper provides new insights into the reciprocal benefits of engaging community Elders and service leaders to work together to develop new and more meaningful ways of servicing Aboriginal families. Foregrounding relationships in service evaluations reinstates the value of human connection and people-centred engagement in service delivery which are central to rebuilding historically fractured relationships between mainstream services and Aboriginal communities. This benefits not only Aboriginal communities, but also other marginalised populations expanding the remit of mainstream services to be accessed by many. Refereed/Peer-reviewed

Over the last decade, the beaching of massive quantities of sargassum in the Caribbean has become a major problem. Relatively few studies have focused on beached sargassum which has numerous negative environmental, social and economic impacts. To aid understanding of the problem and develop approaches to effectively manage it, a satellite-based mapping and monitoring service is being developed on the basis of information generated in a set of user needs workshops. Here, we report on the foundations of this mapping and monitoring service. In particular, user needs obtained from a large and diverse set of stakeholders are used to identify appropriate satellite remote sensing systems to use as data sources. The system will use mainly PlanetScope and Sentinel-2 data to meet the spatio-temporal demands of users. It is planned to develop an operational system that may if desired be extended to the Caribbean as a whole and beyond.

© 2019 Australian Health Promotion Association Issue addressed: Enhancing food skills and nutrition knowledge may help promote healthy eating among people who are food insecure. FoodMate® by SecondBite®, an 8-week nutrition education and food hamper program, focuses on developing food skills and independence among Australians at risk of/experiencing food insecurity. This study aimed to explore participants' perceptions of and experiences with FoodMate® over a long-term (up to 2 years) follow-up. Methods: For evaluation purposes, SecondBite® previously collected data from participants prior to (T1) and following completion (T2) of FoodMate®. This paper reports results from semi-structured telephone interviews conducted in a follow-up study (2016/2017, T3) among 19 adults enrolled in FoodMate® programs delivered in Victoria and New South Wales within the previous two years. Data were analysed using inductive thematic analysis of responses to T3 open-ended questions, and descriptive analysis of closed-ended question responses (T1 vs T2 vs T3). Results: Major qualitative themes included program enjoyment; perceived positive long-term program impact on participants' eating and related attitudes and skills; barriers to cooking; suggested program modifications; and impact on others. In descriptive quantitative analyses, participants' diet; confidence to cook using basic ingredients, follow simple recipes and try new foods; cooking and food-related skills; social engagement and life satisfaction all improved between T1 and T3. Conclusions: Overall, FoodMate® was well-received and associated with long-term positive changes in a range of outcomes. Wider implementation among vulnerable groups should be considered. So what?: Future health promotion initiatives could adopt FoodMate® to increase food skills and knowledge among adults experiencing food insecurity.

While home foreclosure can lead to mental and physical health declines in persons experiencing the foreclosure, whether neighborhood foreclosures can affect the health of other residents is debatable. Using a racially/ethnically diverse sample of Chicago metropolitan area residents linked to foreclosure data from 2008 to 2014, we assessed whether exposure to neighborhood foreclosure fillings was associated with changes in objectively measured body mass index (BMI) over time. Using a retrospective longitudinal design, we employed fixed-effects regression models that controlled for individual- and neighborhood-level covariates to test the association of neighborhood foreclosures and BMI in >60,000 individuals and for individuals who did not move during the follow-up period. We also adjusted for the non-linear association of age and BMI and comorbidities and employed a series of sensitivity analysis to test for robustness. In fully adjusted models, a standard-deviation increase in neighborhood foreclosure filings within 500 m was associated with increases in BMI for individuals who did not move (nonmovers) (mean = 0.03 BMI units, 95% confidence interval: 0.01, 0.06). Neighborhood foreclosure rates were not associated with changes in BMI for the full sample. Given the potential deleterious effects of neighborhood foreclosure on individuals with longer exposure to the local vicinity, clarifying the potential health effects of neighborhood foreclosures would help policymakers when planning actions to prevent home losses, predatory home loans, and that aim to more efficiently return foreclosure properties to productive uses.

The CORINE land cover maps present the longest series of land cover maps with a consistent class labelling system and date back to 1985. This paper presents the results of the CORINE land cover mapping of the United Kingdom for 2012 and the corresponding land cover change map from 2006 to 2012. It compares the rates of change with those of the preceding land cover change map 2000–2006 and finds that land cover change has become smaller in scale, more diverse in types of change and affects more land cover polygons than in the past reporting period. Land cover change from 2006 to 2012 affected almost 60% more land cover polygons than from 2000 to 2006. A greater variety of 165 types of land cover change was detected from 2006 to 2012 than the 67 types of change from 2000 to 2006. The total land cover change area increased by over 21,000 ha or 11% but remained at around 1% of the total land area of the UK. Rotation forestry mostly of conifer forests was a dominant type of land cover change in both periods (53% of overall change from 2000 to 2006 and 54% from 2006 to 2012), followed by growth and replanting of conifer forest. From 2006 to 2012 the replanting rate decreased by almost 15,000 ha compared to 2000–2006 and a smaller decrease in planting of broadleaf and mixed forests was also observed. Urban land take continued from 2006 to 2012 in the UK, with over 16,000 ha of increase in artificial surfaces. The rate of change from other land cover types to artificial surfaces accelerated from 2006 to 2012. However, we urge caution when interpreting the rate of land take, as it includes wind farms in forested areas which leave the forest largely intact apart from an access road and the wind turbine sites. We also found that the inference from the land cover change matrices is dependent on the level of class aggregation (level 1, 2 or 3).

Food-and-mouth disease (FMD) is endemic in Cambodia. The control program for FMD has relied on vaccination, with poor vaccination uptake by smallholder farmers an increasing concern. A study to improve the understanding of farmer knowledge, attitudes and practices of FMD and FMD vaccination was conducted in two Cambodian provinces. The aim was to identify opportunities to improve the disease control programs provided by both the government and private sectors. The survey comprised 300 smallholder farmers using a one-on-one interview technique. Results identified that over two-thirds of the respondent farmers had not vaccinated their cattle over two years. Of those who did, most cattle were vaccinated either once a year or once every three years. A booster had never been administered. FMD outbreaks occurred every year during the study period, with a morbidity rate of over 30%. Isolation of first infected cattle from the household herd was not practiced, with treatment identified as the first preference intervention. Farmers often assisted other farmers to restrain and treat infected cattle both before (57%) and after (43%) their own cattle were infected. This indicated that most farmers did not practice basic biosecurity measures and chose to report FMD outbreaks to the village animal health workers (VAHW), friends, neighbors, and relatives in preference to government officials. It was concluded that poor knowledge of disease transmission and biosecurity, with low FMD vaccination coverage and a focus on treatment, contribute to regular FMD outbreaks in these communities. Improvement of FMD control requires the cooperation of villagers, VAHWs, and village leaders in disease reporting, with either improved funding of government vaccination services or private FMD vaccination service. Training programs for farmers on disease transmission, and the importance of biosecurity and vaccination, including information on the cost-benefits of treatment versus full fee bi-annual FMD vaccination, are required.

Aim The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) core endoscopy e-learning course is designed to provide essential basic training to all endoscopy staff. This study is the first to analyse learners’ use of the e-learning platform and engagement with content. Method Data was extracted from the e-learning for healthcare (e-LFH) platform between Dec 2015 and Dec 2019. The core endoscopy course has 11 individual modules. Data regarding user type, user activity and engagement were collated. Outcomes variables were time per session and completion rates. Descriptive statistics are reported as median and interquartile range (IQR). Statistical differences were assessed using the Kruskal-Wallis test and correlation by Spearman’s rank. Results Between December 2015 and 2019, there were 1835 users of the core endoscopy programme. The top 3 regions based on users were: Midlands (20.6%), North East and Yorkshire (14.9%) and London (12.4%). There was a median of 32 new users per month (IQR 19.5 – 47.5) and 47 active users per month (IQR 30.5 – 71.0). Users included nurses (47.5%), training doctors (16.1%), non-training doctors (11.2%) and healthcare assistants (HCAs; 2.9%). There was no significant difference in active users by month (p = 0.88). There were 12,122 session launches with a median of 28 session launches per month (IQR 17.0 – 46.0). The ‘role of endoscopy’ was the most launched module with a median of 54 launches per month (IQR 31 - 81). Globally, the median completion rate was 42.1% per module (IQR 35.2 – 50.0), which is lower than other similar e-LFH modules (median 48–52%). There were significant differences in completion between modules (p The median time spent per module was 21 minutes (IQR 16 – 28) but there was significant variability in the amount of time spent per module (p = 0.03). There was no significant correlation between module completion rate and time spent (p = 0.05) or number of assessment questions (p = 0.12), but weak correlation with module length (rs 0.35, p There were significant differences between user types and duration of activity (p = 0.001), with HCAs spending the least amount of time per session (median 10 mins, IQR 1 - 20). However, there was no significant difference between staff type and completion rate (p = 0.56). Conclusions There are comparably low completion rates and variability in activity by user groups. These results will inform further changes to the e-LFH endoscopy programme particularly in promoting module completion and improving engagement with specific modules.

This paper studies the impact of U.S. immigration barriers on global knowledge production. We present four key findings. First, among Nobel Prize winners and Fields Medalists, migrants to the U.S. play a central role in the global knowledge network— representing 20-33% of the frontier knowledge producers. Second, using novel survey data and hand-curated life-histories of International Math Olympiad (IMO) medalists, we show that migrants to the U.S. are up to six times more productive than migrants to other countries—even after accounting for talent during one's teenage years. Third, financing costs are a key factor preventing foreign talent from migrating abroad to pursue their dream careers, particularly talent from developing countries. Fourth, certain 'push' incentives that reduce immigration barriers – by addressing financing constraints for top foreign talent – could increase the global scientific output of future cohorts by 42% percent. We conclude by discussing policy options for the U.S. and the global scientific community.

Accurate decoding of nucleic acid variation is critical to understand the complexity and regulation of genome function. Here we use a single-molecule magnetic tweezer (MT) platform to identify sequence variation and map a range of important epigenetic base modifications with high sensitivity, specificity, and precision in the same single molecules of DNA or RNA. We have also developed a highly specific amplification-free CRISPR-Cas enrichment strategy to isolate genomic regions from native DNA. We demonstrate enrichment of DNA from both E. coli and the FMR1 5’UTR coming from cells derived from a Fragile X carrier. From these kilobase-length enriched molecules we could characterize the differential levels of adenine and cytosine base modifications on E. coli, and the repeat expansion length and methylation status of FMR1. Together these results demonstrate that our platform can detect a variety of genetic, epigenetic, and base modification changes concomitantly within the same single molecules., Wang et al. show how genetic sequence and base modifications can be detected simultaneously on single molecules of both DNA and RNA using magnetic tweezers. They also demonstrate an amplification-free CRISPR/Cas9-based strategy for isolating target regions from native DNA and apply this approach to the isolation of targets from E. coli and human genomic DNA.

Background Exclusion of analytical interference is important when there is discrepancy between clinical and laboratory findings. However, interferences on immunoassays are often mistaken as isolated laboratory artefacts. The mechanism of a rare cause of interference in two patients that caused erroneous thyroid function tests, and also affects many other biotin dependent immunoassays, was characterized and reported. Patient findings Patient 1 was a 77-year-old female with worsening fatigue while taking carbimazole over several years. Her thyroid function tests, however, were not suggestive of hypothyroidism. Patient 2 was a 25-year-old female also prescribed carbimazole for apparent primary hyperthyroidism. Despite an elevated free thyroxine, the lowest thyrotropin on record was 0.17 mIU/L. In both cases, thyroid function tests performed by an alternative method were markedly different. Further characterization of both patients' serum demonstrated analytical interference on many immunoassays using the biotin-streptavidin interaction. Sandwich assays (e.g., thyrotropin, follicle-stimulating hormone, troponin T, beta-human chorionic gonadotropin) were falsely low, while competitive assays (e.g., free thyroxine, free triiodothyronine, TSH binding inhibitory immunoglobulin) were falsely high. Pre-incubation of serum with streptavidin microparticles removed the analytical interference, initially suggesting the cause of interference was biotin. However, neither patient had been taking biotin. Instead, a ∼100 kDa immunoglobulin M (IgM) immunoglobulin with high affinity to streptavidin was isolated from each patient's serum. The findings confirm IgM anti-streptavidin antibodies as the cause of analytical interference. Summary Two patients with apparent hyperthyroidism as a result of analytical interference caused by IgM anti-streptavidin antibodies are described. Conclusion Analytical interference identified on one immunoassay should raise the possibility of other affected results. Characterization of interference may help to identify other potentially affected immunoassays. In the case of anti-streptavidin antibodies, the pattern of interference mimics that due to biotin ingestion. However, the degree of interference varies between individual assays and between patients.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. L-arginine was introduced into protein-based freeze-dried formulations to study the ability of arginine to reduce / prevent from protein aggregation during manufacturing, storage and reconstitution of lyophilized protein-based pharmaceuticals. As L-arginine is known to be very hygroscopic, additional excipients which could provide a moisture buffering capacity need to be introduced into the formulation. In the first part of our study – excipient formulation development – the screening of a number of sugars/polyols has been done in order to select the best combination of excipients that, in a complex with L-arginine, can i) produce freeze-dried cakes with elegant appearance, adequate mechanical properties and reconstitution times, and ii) resist/minimize the moisture sorption. Various freeze-dried cakes containing L-arginine in combination with mannitol, trehalose, lactose, and sucrose were produced and analyzed by TGA, DSC, texture analysis, moisture sorption, cake shrinkage, TVIM and SEM. The non-linear dependencies of the physicochemical properties of the freeze-dried cakes on the sugar-to-mannitol ratios were found. The best combinations of excipients (L-arginine, mannitol and trehalose) were selected to be used in the second part of this work, in which the impact of each selected formulation will be studied in relation to the aggregation of a protein.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. Purpose : As a consequence of the latest developments in laser technologies it is now possible to develop a low-cost and accurate tablet inspection system by the unification of optical and artificial intelligence methods. Method: The functionality of the proposed system is based on a sequence of texture analysis of laser speckle images (using laser sources of 650 nm and 808 nm : VIS/IR) followed by the optimization of texture parameters using Bayesian Networks (BN). Results: In the first part of this work, a Bayesian inference method was used to detect micro-scale tablet defects that are generated “progressively” during production whereas in the second part a Bayesian classifier method was used to discriminate between tablets made from different granule sizes. In part two, it was shown that (i) the comparatively higher energy (5mW) IR laser light generates different speckle effects than the lower energy visible (Red 3mW) by interacting with deeper sub-surface of the tablets and (ii) by using multi-classifier systems (MCS) to fuse the Bayesian classifiers from both types of speckle images it was possible to achieve a higher discrimination power (88% classification accuracy) for distinguishing between tablets made from different granule sizes than one can achieve from a single image type. Conclusion: It is suggested that this unified method has the potential to provide for a comprehensive analysis of both tablet quality attributes, on the one hand, and failure modes, on the other, that might be used in the development of a low cost tablet inspection system.

Medicalized environments around the world are challenged with making trade-offs between the clinical nature of the service and the customer service elements needed to deliver the service. Many medicalized wellness services have yet to achieve an effective balance between their hospitality and hospital features to generate loyalty (repeat patronage). We present a case study of a blood service organization in a developed country that, at the time of data collection (2011), was working to resolve tension between clinical goals and expectations of Millennial donors. The results identified seven principles: ‘control over booking and service interactions’; ‘build social connections’; ‘offer a luxury, indulgent experience’; ‘build relationship with customer beyond the “medical” procedure’. The three remaining principles related to hospital-like features: ‘hide the functional/medical features of the service experience’; ‘demystify the “hidden” processes’; ‘ability for the physical service environment to b...

Retaining blood donors is a cost-effective way of ensuring a safe blood supply, yet despite the plethora of research, only 5.1% of the eligible population in Australia donate blood and 40% of these do not make a second donation. We offer an alternative to traditional approaches by conceptualizing blood donation within social representations theory as socially derived symbolic knowledge with a specific focus on cognitive polyphasia and Guimelli's (1998) normative and functional dimensions. An online survey, completed by 703 residents from NSW Australia, comprised a blood donation word association task, Likert-style questions constructed from previous word association data and contextualized blood donation statements. Individual difference scaling analysis revealed all donor groups (including non-donors) associated blood donation with a few central, albeit contradictory ideas/beliefs. Exploratory factor analysis and confirmatory factor analysis performed on a split data set of the Likert-style items reiterated this finding. Interpreted through Guimelli's dichotomy, all donor groups were aware of these contradictory normative and functional ideas/beliefs but when explicitly asked, it was the functional aspect that differentiated the groups. We argue the key to retaining donors is understanding the interdependence between how blood donation is socially understood at the societal level of discourse and donor behaviour. Translational strategies for recruitment and retention are discussed.

Introduction The JAG Basic Skills in Colonoscopy Course is a mandated JAG course designed to help standardise colonoscopy training within the UK. The course is a component of the certification criteria, but the impact of the course on subsequent trainee performance is unknown. We aimed to evaluate colonoscopy performance, as measured using colonoscopy completion metrics, in relation to course attendance. Methods Trainees awarded colonoscopy certification between 201–016 were stratified into 3 groups according to the number of procedures performed prior to the course, 140 procedures. The study outcomes comprised the unassisted caecal intubation rate (CIR) and the Performance Indicator of Colonic Intubation (PICI),1 a composite measure encompassing caecal intubation, sedation and discomfort. Within each group, outcomes rates were calculated for each of the 50 procedures before and after the course. Interrupted time series models were then used to detect step-change improvements occurring after the course. Results A total of 369 trainees were included in the analysis, who performed 140 (N=130) procedures prior to the course. Over the 50 procedures prior to the course, all three groups saw significant linear improvements in CIR, with an average increase of 4.2, 3.6 and 1.7 percentage points for every 10 procedures in the 140 groups, respectively (all p 140 procedure groups, respectively. For PICI, all three groups saw a significant step change improvement, with average increases of 5.6 (p 140 groups, respectively. Based on pre-course trends, the immediate improvement in PICI following course attendance was equivalent to that stemming from performing an additional 1–0 procedures. Conclusions Attendance of the JAG Basic Skills Colonoscopy Course appears to improve PICI in all trainees. CIR data suggests that the optimal timing of course attendance appears to be at earlier stages of colonoscopy training ( References Valori RM, et al. Endoscopy 2018; PMID:28753700

Enhancing food skills and nutrition knowledge may help promote healthy eating among people who are food insecure. FoodMateFor evaluation purposes, SecondBiteMajor qualitative themes included program enjoyment; perceived positive long-term program impact on participants' eating and related attitudes and skills; barriers to cooking; suggested program modifications; and impact on others. In descriptive quantitative analyses, participants' diet; confidence to cook using basic ingredients, follow simple recipes and try new foods; cooking and food-related skills; social engagement and life satisfaction all improved between T1 and T3.Overall, FoodMate

A 55-year-old woman was referred for investigation of an incidental iron deficiency anaemia (haemoglobin 97 g/L; ferritin 10 ug/L and mean cell volume 71.3 fL). The patient had no gastrointestinal symptoms. Upper gastrointestinal endoscopy was normal, with no evidence of coeliac disease on duodenal biopsies. Colonoscopy showed diverticulosis. A capsule endoscopy was then performed, using a new generation dual camera capsule (Mirocam MC2000, Intromedic, Seoul, Korea). This utilises a charge coupled device camera at each end of the capsule, with software that allows the images from each camera to be viewed individually or in combination. Each camera records at three frames per second, and each has a 170° field of view. Compared with a single camera capsule endoscope, dual …

BACKGROUND Anxiety is a frequently cited barrier to blood donor recruitment. Although the mere presence of donation paraphernalia can heighten anxiety for some individuals, such stimuli are a necessary and unavoidable part of donation. Drawing on France and colleagues' research on tailored donor education and coping materials, the current study assessed whether modifying recruitment materials could improve donor recruitment in a context where anxiety is heightened. STUDY DESIGN AND METHODS A field study comprising a 2 (presence or absence of a mobile blood collection unit [MCU]) × 2 (recruitment brochure: standard, coping) between-subjects design was conducted with 922 nondonors who believed themselves eligible to donate blood. In either the presence or absence of the MCU, participants received a standard or modified recruitment brochure modeled on France and colleagues' education and coping materials. Donation anxiety, attitude, subjective norm, self-efficacy, and intention were assessed, and donation behavior was tracked for 30 days. RESULTS Participants who were assessed in the presence of the MCU reported heightened anxiety, and female participants reported decreased self-efficacy. The coping brochure improved self-efficacy, heightened the intention to donate in the presence of the MCU, and promoted blood donation behavior relative to the standard brochure. Path analyses supported a model in which, in the presence of the MCU, the coping brochure boosted self-efficacy and led to increased donation intention and behavior. CONCLUSIONS In a context in which donation-related anxiety is heightened, provision of materials that address prospective donor concerns and suggest coping strategies can bolster self-efficacy and promote recruitment.

Cellular Ti-6Al-4V materials with open-cell pore array structures have been fabricated by Electron Beam Melting (EBM) using an Arcam A2X system. The test samples were cylinders 20 mm diam. x 40 mm high, with pore diameters of 1.75 - 2.5 mm and porosities in the range of 61 - 83%. The structures were based on a simple cubic pore array.Sample stiffness and strength were both found to decrease with increasing porosity, exhibiting mean Young’s moduli of 3.5 – 15.6 GPa and mean yield stresses of 20.2 – 93.6 MPa. Finite element analysis (FEA) using ANSYS was performed to model the stress-strain curves for a representative volume, using measured bulk material properties. Stiffness and strength were significantly overestimated by this method, but better agreement with measured data was obtained when the representative volume was extended along the compression axis.